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Aultman Hospital, Canton, Ohio.
Chest radiographs, computed tomography and gallium scanning are useful in diagnosing the pulmonary manifestations of acquired immunodeficiency syndrome. Most opportunistic infections in patients with AIDS affect the lung as the primary target organ. Bilateral perihilar or basilar interstitial infiltrates, which may progress to the ground-glass appearance of adult respiratory distress syndrome, are commonly seen in cases of Pneumocystis carinii pneumonia. Unilateral or miliary infiltrates and cavitary lesions may be atypical presentations. Diffuse interstitial infiltrates are also seen in mycobacterial, fungal and cytomegalovirus infections. Mycobacterium tuberculosis infection in AIDS patients resembles primary tuberculosis infection rather than secondary tuberculosis reactivation. Intrathoracic adenopathy in AIDS patients suggests neoplastic processes, such as lymphoma and Kaposi's sarcoma, and opportunistic infections such as M. tuberculosis, Mycobacterium avium-intracellulare and fungal infections. Bronchoscopy with bronchoalveolar lavage and transbronchial biopsy are usually necessary for identification of the etiologic agent.
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